<?=$this->load->view('include_header',null)?>
<style type="text/css">
form#form textarea {
    height: 80px;
    overflow: auto;
    padding: 5px;
    width: 420px;
}
</style>
	<div id="top-panel">
		<div id="panel">
			<ul>
				<li class="current"><a href="<?=site_url('archive/idcard/'.$id)?>" class="report"><?=(empty($id))?"录入新":"编辑"?>客户基本信息</a></li>
				<?php if(!empty($info->id)):?><li><a id="printInfo" class="folder_table">打印本页信息</a></li><?php endif;?>
			</ul>
		</div>
	</div>
	<div id="wrapper">
		<div id="content">
			<div id="box">
<!-- table begin -->
<form method="post" id="form"  enctype="multipart/form-data" action="<?=site_url('schengen/au_business_update/'.$cateid)?>">

	<h3>澳大利亚商务申请表[456]</h3>
    <table width="100%">
    <thead>
        <tr>
          <td colspan="3" align="right"><img src="<?= (@$info->avatar)?@$info->avatar:'images/avatar.gif'?>" width="150" height="150" /></td>
		  <td colspan="2" align="right">
		  上传照片<br />
		  <input type="file" name="userphoto"/><br />
		  (.gif|.jpg|.png文件,最大1M)<br />
		  <?php if (@$info->attachment):?><a href="<?= @$info->attachment?>" target="_blank">点击下载附件</a><?php endif; ?>
		  &nbsp;&nbsp;&nbsp;&nbsp;上传附件<br />
		  <input type="file" name="userfile"/><br />
		  (.pdf|.zip|.rar|.doc,最大2M)		  </td>
        </tr>
    </thead>
    <tfoot>
        <tr>
            <td colspan="5" align="right">			
			<input type="hidden" name="id" value="<?=$id?>" />
			<input id="button1" type="submit" value="提交信息" />
			<input id="button2" type="reset" value="重置" />			</td>
        </tr>
    </tfoot>

    <tbody>
		<tr class="odd">
            <td colspan="5">1 Over what period do you wish to visit Australia?</td>
        	</tr>
        <tr class="even">
			<td>&nbsp;</td>
            <td>From(dd-mm-yyyy)</td>
        	<td nowrap="nowrap"><input type="text" name="visit_from" id="visit_from" value="<?= @$info->visit_from?>"/></td>
        	<td><p>To(dd-mm-yyyy)</p>        		</td>
        	<td nowrap="nowrap"><input type="text" name="visit_to" id="visit_to" value="<?= @$info->visit_to?>"/></td>		
        </tr>
		<tr class="odd">
            <td colspan="5">2 Do you intend to enter Australia on more than one occasion?</td>
        	</tr>
        <tr class="even">
			<td>&nbsp;</td>
            <td>
			<input type="radio" name="is_more_enter" value="0" <?= (@$info->is_more_enter==0)?'checked':''?> />No 
        	<input type="radio" name="is_more_enter" value="1" <?= (@$info->is_more_enter==1)?'checked':''?> />Yes			</td>
        	<td colspan="3">Give details<input type="text" name="more_enter" value="<?= @$info->more_enter?>"/></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part A – Your details</strong></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">3 Give your details as shown in your passport</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Family name</td>
        	<td><input type="text" name="surname" value="<?= @$info->surname?>"/></td>
        	<td>Given names</td>
			<td><input type="text" name="firstname" value="<?= @$info->firstname?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Other names you are, or have been, known by	(including name at birth, previous married names, aliases)</td>
        	<td><textarea name="other_name" style="width:110px; height:40px"><?= @$info->given_name?></textarea></td>
        	<td>Name in your own language or script (if applicable)</td>
			<td><input type="text" name="own_language" value="<?= @$info->own_language?>"/></td>
        </tr>
        <tr class="even">
            <td colspan="5">4 Sex</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="sex" value="1" <?= (@$info->sex==1)?'checked':''?> />Male 
        	<input type="radio" name="sex" value="2" <?= (@$info->sex==2)?'checked':''?> />Female</td>
        	</tr>
        <tr class="even">
            <td colspan="5">5 
            	Date of birth (DAY MONTH YEAR) 
            		<input type="text" name="birth" id="birth" value="<?= @$info->birth?>"/></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">6 Place of birth</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Town/city</td>
        	<td><input type="text" name="birth_place" value="<?= @$info->birth_place?>"/></td>
        	<td>Country</td>
			<td><input type="text" name="birth_country" value="<?= @$info->birth_country?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">7 Relationship status</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="marital_status" value="1" <?= (@$info->marital_status==1)?'checked':''?> />Married
        	<input type="radio" name="marital_status" value="2" <?= (@$info->marital_status==2)?'checked':''?> />Engaged
			<input type="radio" name="marital_status" value="3" <?= (@$info->marital_status==3)?'checked':''?> />De facto
			<input type="radio" name="marital_status" value="4" <?= (@$info->marital_status==4)?'checked':''?> />Separated
			<input type="radio" name="marital_status" value="5" <?= (@$info->marital_status==5)?'checked':''?> />Divorced
			<input type="radio" name="marital_status" value="6" <?= (@$info->marital_status==6)?'checked':''?> />Widowed
			<input type="radio" name="marital_status" value="7" <?= (@$info->marital_status==7)?'checked':''?> />Never married or been in a de facto relationship			</td>
        	</tr>
		<tr class="odd">
            <td colspan="5">8 Details from your passport</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Passport number</td>
        	<td><input type="text" name="passport_no" value="<?= @$info->passport_no?>"/></td>
        	<td>Country of passport</td>
			<td><input type="text" name="passport_country" value="<?= @$info->passport_country?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Date of issue</td>
        	<td><input type="text" name="passport_issue" value="<?= @$info->passport_issue?>"/></td>
        	<td>Date of expiry</td>
			<td><input type="text" name="passport_expiry" value="<?= @$info->passport_expiry?>"/></td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Issuing authority/Place of issue as shown in your passport</td>
        	<td><input type="text" name="passport_issue_by" value="<?= @$info->passport_issue_by?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">9 Do you currently hold, or have you applied for, an APEC Business Travel Card (ABTC)?</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="has_apec" value="0" <?= (@$info->has_apec==0)?'checked':''?> />NO  
        	<input type="radio" name="has_apec" value="1" <?= (@$info->has_apec==1)?'checked':''?> />YES			</td>
        	</tr>
		<tr class="odd">
            <td colspan="5">10 Details of identity card or identity number issued to you by your
            	government (if applicable) eg. National identity card.</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Identity number</td>
        	<td><input type="text" name="national_id" value="<?= @$info->national_id?>"/></td>
        	<td>Country of issue</td>
			<td><input type="text" name="issuing_by" value="<?= @$info->issuing_by?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="2">11 Of which countries are you a citizen?</td>
        	<td><input type="text" name="citizen" value="<?= @$info->citizen?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td colspan="2">12 Current occupation</td>
        	<td><input type="text" name="occupation" value="<?= @$info->occupation?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		
        <tr class="odd">
            <td colspan="5">13 Your employment details</td>
        	</tr>
		<tr class="even">
            <td>
			<input type="radio" name="employment_status" value="1" <?= (@$info->employment_status==1)?'checked':''?> />Employed
			<input type="radio" name="employment_status" value="2" <?= (@$info->employment_status==2)?'checked':''?> />self-employed</td>
        	<td align="right">Name</td>
        	<td colspan="3"><input type="text" name="employed_name" value="<?= @$info->employed_name?>"/></td>
			</tr>
        <tr class="odd">
            <td></td>
        	<td align="right">Address</td>
        	<td colspan="3"><input type="text" name="employed_address" value="<?= @$info->employed_address?>" style="width:250px"/>
        	postcode<input type="text" name="employed_postcode" value="<?= @$info->employed_postcode?>" style="width:40px"/></td>
			</tr>
		<tr class="even">
            <td>&nbsp;</td>
        	<td align="right">Telephone number</td>
        	<td colspan="3"><input type="text" name="employed_tel" value="<?= @$info->employed_tel?>"/></td>
			</tr>
        <tr class="odd">
            <td>&nbsp;</td>
        	<td align="right">Position you hold</td>
        	<td colspan="3"><input type="text" name="employed_position" value="<?= @$info->employed_position?>"/></td>
			</tr>
		<tr class="even">
            <td>&nbsp;</td>
        	<td align="right">How long have you been employed by this employer/business?</td>
        	<td colspan="3">
			<input type="text" name="employed_year" value="<?= @$info->employed_year?>" style="width:20px"/>YEARS  
			<input type="text" name="employed_month" value="<?= @$info->employed_month?>" style="width:20px"/>MONTHS			</td>
			</tr>
		
		<tr class="odd">
            <td colspan="5">14 Your current residential address<br />
            	Note: A post office box address is not acceptable as a residential
            	address. Failure to give your residential address will result in this
            	application being invalid.</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="2"><textarea name="residential_address" style="width:220px; height:40px"><?= @$info->residential_address?>
        	</textarea></td>
        	<td>POSTCODE</td>
			<td><input type="text" name="residential_postcode" value="<?= @$info->residential_postcode?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">15 Address for correspondence<br />
            	(If the same as your residential address, write ‘AS ABOVE’)</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td colspan="2"><textarea name="postal_address" style="width:220px; height:40px"><?= @$info->postal_address?>
        	</textarea></td>
        	<td>POSTCODE</td>
			<td><input type="text" name="postal_postcode" value="<?= @$info->postal_postcode?>"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">16 Your contact numbers</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>AREA CODE</td>
			<td>NUMBER</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Office hours</td>
        	<td><input type="text" name="tel1_area" value="<?= @$info->tel1_area?>"/></td>
			<td><input type="text" name="tel1_no" value="<?= @$info->tel1_no?>"/></td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>After hours or
        		mobile/cell</td>
        	<td><input type="text" name="tel2_area" value="<?= @$info->tel2_area?>"/></td>
			<td><input type="text" name="tel2_no" value="<?= @$info->tel2_no?>"/></td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td colspan="5">17 Do you agree to the department communicating with you by fax,e-mail or other electronic means?</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>
			<input type="radio" name="is_agress_contact" value="0" <?= (@$info->is_agress_contact==0)?'checked':''?> />No 
        	<input type="radio" name="is_agress_contact" value="1" <?= (@$info->is_agress_contact==1)?'checked':''?> />Yes			</td>
        	<td>Give details</td>
        	<td colspan="2">Fax number
				<input type="text" name="fax_area" value="<?= @$info->fax_area?>" style="width:30px"/>
				<input type="text" name="fax_no" value="<?= @$info->fax_no?>"/>			</td>
			</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td colspan="2">E-mail address
        		<input type="text" name="email" value="<?= @$info->email?>" id="email"/></td>
			</tr>
        <tr class="even">
            <td colspan="5">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><strong>Part B – Business activities</strong></td>
        	</tr>
        <tr class="even">
            <td colspan="5">18 Describe your intended principal business activity in Australia</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4"><textarea name="business_desc"><?= @$info->business_desc?>
        	</textarea></td>
        	</tr>
        <tr class="even">
            <td>Australian business contact</td>
        	<td>Contact person</td>
        	<td colspan="3"><input type="text" name="contact_person" value="<?= @$info->contact_person?>"/></td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Business name (if applicable)</td>
        	<td colspan="3"><input type="text" name="contact_name" value="<?= @$info->contact_name?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Telephone number</td>
        	<td colspan="3">AREA CODE
        		<input type="text" name="contact_area" value="<?= @$info->contact_area?>" style="width:30px"/>
        		<input type="text" name="contact_tel" value="<?= @$info->contact_tel?>"/></td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Address</td>
        	<td colspan="3"><input type="text" name="contact_address" value="<?= @$info->contact_address?>" style="width:250px"/>
        		POSTCODE
        			<input type="text" name="contact_postcode" value="<?= @$info->contact_postcode?>"/></td>
        	</tr>
        <tr class="even">
            <td colspan="5">19 Will you be in paid employment in Australia?</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>
			<input type="radio" name="has_employer" value="0" <?= (@$info->has_employer==0)?'checked':''?> />No 
        	<input type="radio" name="has_employer" value="1" <?= (@$info->has_employer==1)?'checked':''?> />Yes	
			Provide details of your employment in Australia</td>
        	<td>Occupation</td>
        	<td colspan="2" class="even"><input type="text" name="employer_occupation" value="<?= @$info->employer_occupation?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Employer’s name</td>
        	<td colspan="2" class="odd"><input type="text" name="employer_name" value="<?= @$info->employer_name?>"/></td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Contact person</td>
        	<td colspan="2" class="even"><input type="text" name="employer_contact" value="<?= @$info->employer_contact?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Telephone number</td>
        	<td colspan="2" class="odd">AREA CODE
        		<input type="text" name="employer_area" value="<?= @$info->employer_area?>" style="width:30px"/>
        		<input type="text" name="employer_tel" value="<?= @$info->employer_tel?>"/></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part C – Health</strong></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">20 In the last 5 years, have you, or any other person included in this
            	application, visited, or lived, outside your country of passport for more
            	than 3 consecutive months?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_outside" value="0" <?= (@$info->has_outside==0)?'checked':''?> />No 
        	<input type="radio" name="has_outside" value="1" <?= (@$info->has_outside==1)?'checked':''?> />Yes Give details</td>
        	<td>1</td>
        	<td>Name</td>
        	<td colspan="2"><input type="text" name="outside1_name" value="<?= @$info->outside1_name?>"/></td>
			</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Country(s)</td>
        	<td colspan="2"><input type="text" name="outside1_country" value="<?= @$info->outside1_country?>"/></td>
			</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Date from(dd-mm-yyy)</td>
        	<td colspan="2"><input type="text" name="outside1_from" id="outside1_from" value="<?= @$info->outside1_from?>" style="width:80px"/> 
        		TO <input type="text" name="outside1_to" id="outside1_to" value="<?= @$info->outside1_to?>" style="width:80px"/></td>
			</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>2</td>
        	<td class="even">Name</td>
        	<td colspan="2" class="even"><input type="text" name="outside2_name" value="<?= @$info->outside2_name?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="odd">Country(s)</td>
        	<td colspan="2" class="odd"><input type="text" name="outside2_country" value="<?= @$info->outside2_country?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td class="even">Date from(dd-mm-yyy)</td>
        	<td colspan="2" class="even"><input type="text" name="outside2_from" id="outside2_from" value="<?= @$info->outside2_from?>" style="width:80px"/>
        		TO
        		<input type="text" name="outside2_to" id="outside2_to" value="<?= @$info->outside2_to?>" style="width:80px"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>3</td>
        	<td>Name</td>
        	<td colspan="2"><input type="text" name="outside3_name" value="<?= @$info->outside3_name?>"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Country(s)</td>
        	<td colspan="2"><input type="text" name="outside3_country" value="<?= @$info->outside3_country?>"/></td>
		</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>Date from(dd-mm-yyy)</td>
        	<td colspan="2"><input type="text" name="outside3_from" id="outside3_from" value="<?= @$info->outside3_from?>" style="width:80px"/>
        		TO
        		<input type="text" name="outside3_to" id="outside3_to" value="<?= @$info->outside3_to?>" style="width:80px"/></td>
        </tr>
		<tr class="odd">
            <td colspan="5">21 Do you, or any other person included in this application, intend to enter
            	a hospital or a health care facility (including nursing homes) while in
            	Australia?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_go_hospital" value="0" <?= (@$info->has_go_hospital==0)?'checked':''?> />No 
        	<input type="radio" name="has_go_hospital" value="1" <?= (@$info->has_go_hospital==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="go_hospital"><?= @$info->go_hospital?>
        	</textarea></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">22 Do you, or any other person included in this application, intend to work
            	as, or study to be, a doctor, dentist, nurse or paramedic during your
            	stay in Australia?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_go_work" value="0" <?= (@$info->has_go_work==0)?'checked':''?> />No 
        	<input type="radio" name="has_go_work" value="1" <?= (@$info->has_go_work==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="go_work"><?= @$info->go_work?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">23 Do you, or any other person included in this application, intend to work,
            	or be a trainee, at a child care centre (including preschools and creches)
            	while in Australia?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_go_preschools" value="0" <?= (@$info->has_go_preschools==0)?'checked':''?> />No 
        	<input type="radio" name="has_go_preschools" value="1" <?= (@$info->has_go_preschools==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="go_preschools"><?= @$info->go_preschools?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">24 Have you, or any other person included in this application:<br />
            	。ever had, or currently have, tuberculosis?<br />
            	。been in close contact with a family member that has active tuberculosis?<br />
            	。ever had a chest x-ray which showed an abnormality?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_tuberculosis" value="0" <?= (@$info->has_tuberculosis==0)?'checked':''?> />No 
        	<input type="radio" name="has_tuberculosis" value="1" <?= (@$info->has_tuberculosis==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="tuberculosis"><?= @$info->tuberculosis?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">25 During your proposed visit to Australia, do you, or any other person included in this application, expect to incur medical costs, or require treatment or medical follow up for:<br />
            	。blood disorder;<br />
            	。cancer;<br />
            	。heart disease;<br />
            	。hepatitis B or C and/or liver disease;<br />
            	。HIV infection, including AIDS;<br />
            	。kidney disease, including dialysis;<br />
            	。mental illness;<br />
            	。pregnancy;<br />
            	。respiratory disease that has required hospital admission or oxygen therapy;<br />
            	。other?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_treatment" value="0" <?= (@$info->has_treatment==0)?'checked':''?> />No 
        	<input type="radio" name="has_treatment" value="1" <?= (@$info->has_treatment==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="treatment"><?= @$info->treatment?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">26 Do you, or any other person included in this application, require assistance with mobility or care due to a medical condition?</td>
        	</tr>
        <tr class="even">
            <td><input type="radio" name="has_need_assistance" value="0" <?= (@$info->has_need_assistance==0)?'checked':''?> />No 
        	<input type="radio" name="has_need_assistance" value="1" <?= (@$info->has_need_assistance==1)?'checked':''?> />Yes Give details</td>
        	<td colspan="4"><textarea name="need_assistance"><?= @$info->need_assistance?>
        	</textarea></td>
        </tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part D – Character</strong></td>
        </tr>
		<tr class="odd">
            <td colspan="5">27 Have you, or has any member of your family unit included in this application, ever:</td>
        	</tr>
        <tr class="even">
            <td colspan="4">• been convicted of a crime or offence in any
            	country (including any conviction which is
            	now removed from official records)?</td>
        	<td><input type="radio" name="is_field27_1" value="0" <?= (@$info->is_field27_1==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_1" value="1" <?= (@$info->is_field27_1==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">• been charged with any offence that is
            	currently awaiting legal action?</td>
        	<td><input type="radio" name="is_field27_2" value="0" <?= (@$info->is_field27_2==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_2" value="1" <?= (@$info->is_field27_2==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">• been acquitted of any criminal offence or
            	other offence on the grounds of mental
            	illness, insanity or unsoundness of mind?</td>
        	<td><input type="radio" name="is_field27_3" value="0" <?= (@$info->is_field27_3==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_3" value="1" <?= (@$info->is_field27_3==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">• been removed or deported from any country
            	(including Australia)?</td>
        	<td><input type="radio" name="is_field27_4" value="0" <?= (@$info->is_field27_4==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_4" value="1" <?= (@$info->is_field27_4==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">• left any country to avoid being removed
            	or deported?</td>
        	<td><input type="radio" name="is_field27_5" value="0" <?= (@$info->is_field27_5==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_5" value="1" <?= (@$info->is_field27_5==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">• been refused a visa for Australia or another
            	country?</td>
        	<td><input type="radio" name="is_field27_6" value="0" <?= (@$info->is_field27_6==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_6" value="1" <?= (@$info->is_field27_6==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">• been excluded from or asked to leave any
            	country (including Australia)?</td>
        	<td><input type="radio" name="is_field27_7" value="0" <?= (@$info->is_field27_7==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_7" value="1" <?= (@$info->is_field27_7==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">• committed, or been involved in the
            	commission of war crimes or crimes against
            	humanity or human rights?</td>
        	<td><input type="radio" name="is_field27_8" value="0" <?= (@$info->is_field27_8==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_8" value="1" <?= (@$info->is_field27_8==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">• been involved in any activities that would
            	represent a risk to Australian national
            	security?</td>
        	<td><input type="radio" name="is_field27_9" value="0" <?= (@$info->is_field27_9==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_9" value="1" <?= (@$info->is_field27_9==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="odd">
            <td colspan="4">• had any outstanding debts to the Australian
            	Government or any public authority in
            	Australia?</td>
        	<td><input type="radio" name="is_field27_10" value="0" <?= (@$info->is_field27_10==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_10" value="1" <?= (@$info->is_field27_10==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="even">
            <td colspan="4">• been involved in any activity, or been
            	convicted of any offence, relating to the
            	illegal movement of people to any country
            	(including Australia)?</td>
        	<td><input type="radio" name="is_field27_11" value="0" <?= (@$info->is_field27_11==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_11" value="1" <?= (@$info->is_field27_11==1)?'checked':''?> />Yes</td>
        </tr>
        <tr class="odd">
            <td colspan="4">• served in a military force or state
            	sponsored/private militia, undergone any
            	military/paramilitary training, or been trained
            	in weapons/explosives use (however
            	described)?</td>
        	<td><input type="radio" name="is_field27_12" value="0" <?= (@$info->is_field27_12==0)?'checked':''?> />No 
        	<input type="radio" name="is_field27_12" value="1" <?= (@$info->is_field27_12==1)?'checked':''?> />Yes</td>
        </tr>
		<tr class="even">
		    <td>If you answered ‘Yes’ to any of the above questions, provide all the
relevant details. If insufficient space, attach an additional statement.</td>
            <td colspan="4"><textarea name="field27"><?= @$info->field27?></textarea></td>
        </tr>
        <tr class="even">
            <td colspan="5">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><strong>Part E – Accompanying family members</strong></td>
        	</tr>
        <tr class="even">
            <td colspan="5">Family member includes your spouse or de facto partner and dependent
            	children who are unmarried and not in a de facto relationship.</td>
        	</tr>
		<tr class="odd">
            <td colspan="3">28 Are there any family members who are to be included in this application
            	(including those shown in your passport)?</td>
        	<td colspan="2">
			<input type="radio" name="has_member" value="0" <?= (@$info->has_member==0)?'checked':''?> />No Go to Part F<br />
        	<input type="radio" name="has_member" value="1" <?= (@$info->has_member==1)?'checked':''?> />Yes Give details of accompanying family members
at Question 29</td>
			</tr>
        <tr class="even">
            <td colspan="5">29 Give details of each family member who is included in this application
            	(including those shown in your passport, if they are accompanying you).<br />
            	Provide details as shown in the person’s passport.<br />
            	Each person must sign the form where indicated below. If the person is
            	too young to sign, the parent or guardian may sign on their behalf.<br />
            	By signing, they are making the same declaration as at Part H.</td>
        	</tr>
		<tr class="odd">
            <td align="right">1. Family name</td>
        	<td><input type="text" name="member1_family_name" value="<?= @$info->member1_family_name?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">2. Family name</td>
        	<td><input type="text" name="member2_family_name" value="<?= @$info->member2_family_name?>"/></td>
		</tr>
        <tr class="even">
            <td align="right">Given names</td>
        	<td><input type="text" name="member1_given_name" value="<?= @$info->member1_given_name?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Given names</td>
        	<td><input type="text" name="member2_given_name" value="<?= @$info->member2_given_name?>"/></td>
        </tr>
		<tr class="odd">
           <td align="right">Date of birth(dd-mm-yyyy)</td>
        	<td><input type="text" name="member1_birth" id="member1_birth" value="<?= @$info->member1_birth?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Date of birth(dd-mm-yyyy)</td>
        	<td><input type="text" name="member2_birth" id="member2_birth" value="<?= @$info->member2_birth?>"/></td>
		</tr>
        <tr class="even">
            <td align="right">Sex</td>
        	<td><input type="radio" name="member1_sex" value="1" <?= (@$info->member1_sex==1)?'checked':''?> />Male 
        	<input type="radio" name="member1_sex" value="2" <?= (@$info->member1_sex==2)?'checked':''?> />Female</td>
        	<td>&nbsp;</td>
        	<td align="right">Sex</td>
        	<td><input type="radio" name="member2_sex" value="1" <?= (@$info->member2_sex==1)?'checked':''?> />
        		Male
        		<input type="radio" name="member2_sex" value="2" <?= (@$info->member2_sex==2)?'checked':''?> />
        		Female</td>
        </tr>
		<tr class="odd">
           <td align="right">Relationship to
           	main applicant</td>
        	<td><input type="text" name="member1_relate" value="<?= @$info->member1_relate?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Relationship to
        		main applicant</td>
        	<td><input type="text" name="member2_relate" value="<?= @$info->member2_relate?>"/></td>
		</tr>
        <tr class="even">
            <td align="right">Place of birth</td>
        	<td><input type="text" name="member1_birth_place" value="<?= @$info->member1_birth_place?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Place of birth</td>
        	<td><input type="text" name="member2_birth_place" value="<?= @$info->member2_birth_place?>"/></td>
        </tr>
		<tr class="odd">
            <td align="right">Country(ies) of
            	citizenship</td>
        	<td><input type="text" name="member1_citizen" value="<?= @$info->member1_citizen?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Country(ies) of
        		citizenship</td>
        	<td><input type="text" name="member2_citizen" value="<?= @$info->member2_citizen?>"/></td>
		</tr>
        <tr class="even">
            <td align="right">Passport number</td>
        	<td><input type="text" name="member1_passport" value="<?= @$info->member1_passport?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Passport number</td>
        	<td><input type="text" name="member2_passport" value="<?= @$info->member2_passport?>"/></td>
        </tr>
		<tr class="odd">
            <td align="right">Country of
            	passport</td>
        	<td><input type="text" name="member1_passport_country" value="<?= @$info->member1_passport_country?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Country of
        		passport</td>
        	<td><input type="text" name="member2_passport_country" value="<?= @$info->member2_passport_country?>"/></td>
		</tr>
		<tr class="even">
            <td align="right">Date of issue(dd-mm-yyyy))</td>
        	<td><input type="text" name="member1_passport_issue" id="member1_passport_issue" value="<?= @$info->member1_passport_issue?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Date of issue(dd-mm-yyyy)</td>
        	<td><input type="text" name="member2_passport_issue" id="member2_passport_issue" value="<?= @$info->member2_passport_issue?>"/></td>
		</tr>
		<tr class="odd">
            <td align="right">Date of expiry(dd-mm-yyyy)</td>
        	<td><input type="text" name="member1_passport_expiry" id="member1_passport_expiry" value="<?= @$info->member1_passport_expiry?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Date of expiry(dd-mm-yyyy)</td>
        	<td><input type="text" name="member2_passport_expiry" id="member2_passport_expiry" value="<?= @$info->member2_passport_expiry?>"/></td>
		</tr>
		<tr class="even">
            <td align="right">Issuing authority/
            	Place of issue as
            	shown in passport</td>
        	<td><input type="text" name="member1_passport_by" value="<?= @$info->member1_passport_by?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Issuing authority/
        		Place of issue as
        		shown in passport</td>
        	<td><input type="text" name="member2_passport_by" value="<?= @$info->member2_passport_by?>"/></td>
		</tr>
		<tr class="odd">
            <td align="right">Identity number</td>
        	<td><input type="text" name="member1_id" value="<?= @$info->member1_id?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Identity number</td>
        	<td><input type="text" name="member2_id" value="<?= @$info->member2_id?>"/></td>
		</tr>
		<tr class="even">
            <td align="right">Country of issue</td>
        	<td><input type="text" name="member1_id_by" value="<?= @$info->member1_id_by?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Country of issue</td>
        	<td><input type="text" name="member2_id_by" value="<?= @$info->member2_id_by?>"/></td>
		</tr>
		<tr class="odd">
            <td align="right">Date(dd-mm-yyyy)</td>
        	<td><input type="text" name="member1_date" id="member1_date" value="<?= @$info->member1_date?>"/></td>
        	<td>&nbsp;</td>
        	<td align="right">Date(dd-mm-yyyy)</td>
        	<td><input type="text" name="member2_date" id="member2_date" value="<?= @$info->member2_date?>"/></td>
		</tr>
		<tr class="even">
			<td align="right" class="odd">3. Family name</td>
            <td class="odd"><input type="text" name="member3_family_name" value="<?= @$info->member3_family_name?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="odd">
			<td align="right" class="even">Given names</td>
            <td class="even"><input type="text" name="member3_given_name" value="<?= @$info->member3_given_name?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="even">
			<td align="right" class="odd">Date of birth(dd-mm-yyyy)</td>
            <td class="odd"><input type="text" name="member3_birth" id="member3_birth" value="<?= @$info->member3_birth?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="odd">
			<td align="right" class="even">Sex</td>
            <td class="even"><input type="radio" name="member3_sex" value="1" <?= (@$info->member3_sex==1)?'checked':''?> />
            	Male
            	<input type="radio" name="member3_sex" value="2" <?= (@$info->member3_sex==2)?'checked':''?> />
            	Female</td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="even">
			<td align="right" class="odd">Relationship to
				main applicant</td>
            <td class="odd"><input type="text" name="member3_relate" value="<?= @$info->member3_relate?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="odd">
			<td align="right" class="even">Place of birth</td>
            <td class="even"><input type="text" name="member3_birth_place" value="<?= @$info->member3_birth_place?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="even">
			<td align="right" class="odd">Country(ies) of
				citizenship</td>
            <td class="odd"><input type="text" name="member3_citizen" value="<?= @$info->member3_citizen?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="odd">
			<td align="right" class="even">Passport number</td>
            <td class="even"><input type="text" name="member3_passport" value="<?= @$info->member3_passport?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="even">
			<td align="right" class="odd">Country of
				passport</td>
            <td class="odd"><input type="text" name="member3_passport_country" value="<?= @$info->member3_passport_country?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="odd">
			<td align="right" class="even">Date of issue</td>
            <td class="even"><input type="text" name="member3_passport_issue" id="member3_passport_issue" value="<?= @$info->member3_passport_issue?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="even">
			<td align="right" class="odd">Date of expiry</td>
            <td class="odd"><input type="text" name="member3_passport_expiry" id="member3_passport_expiry" value="<?= @$info->member3_passport_expiry?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="odd">
			<td align="right" class="even">Issuing authority/
				Place of issue as
				shown in passport</td>
            <td class="even"><input type="text" name="member3_passport_by" value="<?= @$info->member3_passport_by?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="even">
			<td align="right" class="odd">Identity number</td>
            <td class="odd"><input type="text" name="member3_id" value="<?= @$info->member3_id?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="odd">
			<td align="right" class="even">Country of issue</td>
            <td class="even"><input type="text" name="member3_id_by" value="<?= @$info->member3_id_by?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="even">
			<td align="right" class="odd">Date</td>
            <td class="odd"><input type="text" name="member3_date" id="member3_date" value="<?= @$info->member3_date?>"/></td>
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr class="odd">
            <td colspan="5">30 Will any of the family members listed in response to Question 29 be in
            	paid employment or be undertaking studies while in Australia?</td>
        	</tr>
		<tr class="even">
            <td>&nbsp;</td>
        	<td><input type="radio" name="has_member_detail" value="0" <?= (@$info->has_member_detail==0)?'checked':''?> />No 
        	<input type="radio" name="has_member_detail" value="1" <?= (@$info->has_member_detail==1)?'checked':''?> />Yes Provide details</td>
        	<td colspan="3"><textarea name="member_detail"><?= @$info->member_detail?>
        	</textarea></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">&nbsp;</td>
        	</tr>
        <tr class="even">
            <td colspan="5"><strong>Part F – Assistance with this form</strong></td>
        	</tr>
		<tr class="odd">
            <td colspan="5">31 Did you receive assistance in completing this form?</td>
        	</tr>
        <tr class="even">
            <td colspan="5">
			<input type="radio" name="is_assistance" value="0" <?= (@$info->is_assistance==0)?'checked':''?> />
			No Go to Part G 
        	<input type="radio" name="is_assistance" value="1" <?= (@$info->is_assistance==1)?'checked':''?> />Yes Please give details of the person who assisted you			</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4">Title: 
			<input type="radio" name="assistance_title" value="1" <?= (@$info->assistance_title==1)?'checked':''?> />Mr 
        	<input type="radio" name="assistance_title" value="2" <?= (@$info->assistance_title==2)?'checked':''?> />Mrs 
			<input type="radio" name="assistance_title" value="3" <?= (@$info->assistance_title==3)?'checked':''?> />Miss 
        	<input type="radio" name="assistance_title" value="4" <?= (@$info->assistance_title==4)?'checked':''?> />Ms 
			Other<input type="text" name="assistance_title_other" value="<?= @$info->assistance_title_other?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Family name</td>
        	<td><input type="text" name="assistance_family_name" value="<?= @$info->assistance_family_name?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Given names</td>
        	<td><input type="text" name="assistance_given_name" value="<?= @$info->assistance_given_name?>"/></td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Address</td>
        	<td colspan="2"><input type="text" name="assistance_address" value="<?= @$info->assistance_address?>" style="width:250px"/></td>
        	<td>POSTCODE
        		<input type="text" name="assistance_postcode" value="<?= @$info->assistance_postcode?>" style="width:50px"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Office hours</td>
        	<td colspan="3">COUNTRY CODE AREA CODE NUMBER<br />
			<input type="text" name="assistance_country" value="<?= @$info->assistance_country?>" style="width:30px"/>
			<input type="text" name="assistance_area" value="<?= @$info->assistance_area?>" style="width:30px"/>
			<input type="text" name="assistance_no" value="<?= @$info->assistance_no?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Mobile/cell</td>
        	<td colspan="3"><input type="text" name="assistance_tel" value="<?= @$info->assistance_tel?>"/></td>
        	</tr>
		<tr class="odd">
            <td colspan="4">32 Is the person an agent registered with the Office of the Migration
            	Agents Registration Authority (Office of the MARA)?</td>
        	<td>
			<input type="radio" name="is_field32" value="0" <?= (@$info->is_field32==0)?'checked':''?> />No 
        	<input type="radio" name="is_field32" value="1" <?= (@$info->is_field32==1)?'checked':''?> />Yes Go to Part G</td>
        </tr>
        <tr class="even">
            <td colspan="4">33 Is the person/agent in Australia?</td>
        	<td>
			<input type="radio" name="is_field33" value="0" <?= (@$info->is_field33==0)?'checked':''?> />No Go to Part G
        	<input type="radio" name="is_field33" value="1" <?= (@$info->is_field33==1)?'checked':''?> />Yes			</td>
        </tr>
		<tr class="odd">
            <td colspan="4">34 Did you pay the person/agent and/or give a gift for this assistance?</td>
        	<td>
			<input type="radio" name="is_field34" value="0" <?= (@$info->is_field34==0)?'checked':''?> />No 
        	<input type="radio" name="is_field34" value="1" <?= (@$info->is_field34==1)?'checked':''?> />Yes			</td>
        </tr>
        <tr class="even">
            <td colspan="5">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><strong>Part G – Options for receiving written communications</strong></td>
        	</tr>
        <tr class="even">
            <td colspan="5">35 All written communications about this application should be sent to:
            	(Tick one box only)</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="field42" value="1" <?= (@$info->field42==1)?'checked':''?> />Myself 
        	<input type="radio" name="field42" value="2" <?= (@$info->field42==2)?'checked':''?> />Authorised recipient 
			<input type="radio" name="field42" value="3" <?= (@$info->field42==3)?'checked':''?> />Migration agent  
        	<input type="radio" name="field42" value="4" <?= (@$info->field42==4)?'checked':''?> />Agent exempt from registration			</td>
        </tr>
		<tr class="even">
            <td colspan="5"><strong>Part H – Declaration and consent</strong></td>
        	</tr>
		<tr class="odd">
            <td>36 Applicant</td>
        	<td>Signature of DATE (dd-mm-yyyy) </td>
        	<td colspan="3"><input type="text" name="applicant_sign_date" id="applicant_sign_date" value="<?= @$info->applicant_sign_date?>"/></td>
        </tr>
		<tr class="odd">
            <td>37 Parent/guardian</td>
        	<td>Signature of DATE (dd-mm-yyyy) </td>
        	<td colspan="3"><input type="text" name="guardian_sign_date" id="guardian_sign_date" value="<?= @$info->guardian_sign_date?>"/></td>
        </tr>
        <tr class="even">
            <td colspan="5">&nbsp;</td>
        	</tr>
		<tr class="odd">
            <td colspan="5"><strong>Part I – Payment details</strong></td>
        	</tr>
        <tr class="even">
            <td colspan="5">43 How will you pay your application charge?</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td colspan="4">
			<input type="radio" name="pay_type" value="1" <?= (@$info->pay_type==1)?'checked':''?> />Bank cheque 
        	<input type="radio" name="pay_type" value="2" <?= (@$info->pay_type==2)?'checked':''?> />Money order 
			<input type="radio" name="pay_type" value="3" <?= (@$info->pay_type==3)?'checked':''?> />Debit card (Cannot be used for applications lodged by mail) 
        	<input type="radio" name="pay_type" value="4" <?= (@$info->pay_type==4)?'checked':''?> />Credit card (Give details below)			</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Payment by (tick one box)</td>
        	<td colspan="3">
			<input type="radio" name="card_type" value="1" <?= (@$info->card_type==1)?'checked':''?> />MasterCard 
        	<input type="radio" name="card_type" value="2" <?= (@$info->card_type==2)?'checked':''?> />American Express 
			<input type="radio" name="card_type" value="3" <?= (@$info->card_type==3)?'checked':''?> />Visa 
        	<input type="radio" name="card_type" value="4" <?= (@$info->card_type==4)?'checked':''?> />Diners Club 
			<input type="radio" name="card_type" value="5" <?= (@$info->card_type==5)?'checked':''?> />JCB			</td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Australian Dollars</td>
        	<td colspan="3"><input type="text" name="card_dollar" value="<?= @$info->card_dollar?>"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Credit card number</td>
        	<td colspan="3"><input type="text" name="card_no" value="<?= @$info->card_no?>" style="width:250px"/></td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Expiry date</td>
        	<td colspan="3">MONTH<input type="text" name="card_expiry_month" value="<?= @$info->card_expiry_month?>" style="width:15px"/> / YEAR<input type="text" name="card_expiry_year" value="<?= @$info->card_expiry_year?>" style="width:30px"/></td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Cardholder’s name</td>
        	<td colspan="3"><input type="text" name="cardholder_name" value="<?= @$info->cardholder_name?>"/></td>
        	</tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>Telephone number</td>
        	<td colspan="3">
			COUNTRY CODE AREA CODE NUMBER<br />
			<input type="text" name="cardholder_country" value="<?= @$info->cardholder_country?>" style="width:30px"/>
			<input type="text" name="cardholder_area" value="<?= @$info->cardholder_area?>" style="width:30px"/>
			<input type="text" name="cardholder_no" value="<?= @$info->cardholder_no?>"/>			</td>
        	</tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>Address</td>
        	<td colspan="2"><input type="text" name="cardholder_address" value="<?= @$info->cardholder_address?>" style="width:250px"/></td>
        	<td>POSTCODE
				<input type="text" name="cardholder_postcode" value="<?= @$info->cardholder_postcode?>" style="width:50px"/></td>
        </tr>
		<tr class="odd">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
        <tr class="even">
            <td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
        	<td>&nbsp;</td>
			<td>&nbsp;</td>
        </tr>
    </tbody>
	</table>
<!-- table end -->
</form>

			</div>
		</div>
		
		<?=$this->load->view('include_sidebar',array('id'=>$id,'forms'=>$forms))?>
	</div>

<script type="text/javascript">
$().ready(function() {
  $("#form").validate({
    rules: {
		visit_from:"required",
		visit_to:"required",
		visit_stay:"required",
		is_more_enter:"required",
		sex:"required",
		family_name:"required",
		given_name:"required",
		marital_status:"required"
    }
  });
  
	$.datepicker.setDefaults(
		{
		dateFormat: 'dd-mm-yy',
		changeMonth: true,
		changeYear: true,
		showOn: "both",
		buttonImage: "images/calendar.gif",
		buttonImageOnly: true
		}
	);
	$("#visit_from").datepicker();
	$("#visit_to").datepicker();
	$("#birth").datepicker();
	$("#outside1_from").datepicker();
	$("#outside1_to").datepicker();
	$("#outside2_from").datepicker();
	$("#outside2_to").datepicker();
	$("#outside3_from").datepicker();
	$("#outside3_to").datepicker();
	$("#member1_birth").datepicker();
	$("#member2_birth").datepicker();
	$("#member3_birth").datepicker();
	$("#member1_passport_issue").datepicker();
	$("#member2_passport_issue").datepicker();
	$("#member3_passport_issue").datepicker();
	$("#member1_passport_expiry").datepicker();
	$("#member2_passport_expiry").datepicker();
	$("#member3_passport_expiry").datepicker();
	$("#member1_date").datepicker();
	$("#member2_date").datepicker();
	$("#member3_date").datepicker();
	$("#applicant_sign_date").datepicker();
	$("#guardian_sign_date").datepicker();
	
	$("#email").autoMail();
	
	$("#printInfo").click(function(o) {
		var prints = [
			{rel_id: <?=$cateid?>, rec_id: <?=$id?>}
		]  ;
		
		var jdata = JSON.stringify(prints);
		//alert(jdata);
		$.post("<?=site_url('proxy/does/'.str_replace('==','',base64_encode('http://'.$_SERVER['SERVER_NAME'].':9090/javaprduct/servlet/test')))?>",{clients:jdata},function(msg){alert(msg)});
	});
	
	$("#printInfo").ajaxError(function(event,request, settings){
		//$(this).append("<li>出错页面:" + settings.url + "</li>");
		alert("无法访问"+ settings.url );
	}); 
 
});
</script>

<?=$this->load->view('include_footer',null)?>